Diagnostic and therapeutic difficulty of chondrosarcoma of the temporomandibular joint: Two cases report

Abstract

Chondrosarcoma is a malignant tumor characterized by cartilaginous formation. It represents approximately 0.1% of all head and neck neoplasms. Its localization in the temporomandibular joint (TMJ) remains extremely rare. The authors report two cases of Chondrosarcoma of the Temporomandibular Joint. The aim of this paper is to emphasize the diagnostic and therapeutic difficulty in this pathology.

Highlights

  • Chondrosarcoma is a malignant tumor whose stroma produces cartilage tissue.

  • Chondrosarcoma is extremely rare in the temporomandibular joint.

  • Tumor in the temporomandibular joint area is difficult to access for biopsy.

  • The bony origin of this tumor excludes the possibility of an extemporaneous examination.

  • The advantage of imaging for any temporomandibular joint dysfunction is to exclude a tumor process.

Introduction

Chondrosarcoma is a malignant tumor whose stroma produces cartilage tissue [ ]. It is the third most common malignant bone tumor after myeloma and osteosarcoma, representing 10–20% of primary bone tumors. Chondrosarcoma, is a primary bone tumor that commonly occurs in the pelvis, ribs, femur, and humerus, but the rate of occurrence in the head and neck region does not exceed 0.1% of all head and neck neoplasms [ ]. Only about thirty cases of chondrosarcoma of the TMJ have been reported in the English literature. The clinical presentation typically refers to the most common pathologies like temporomandibular disorder, internal derangement, disc displacement, degenerative joint disease, which leads to diagnostic delay. Imaging is very important to detect or evoke the presence of a tumor, but the diagnosis can only be made histopathologically. In some cases, it can lead to tumors of neighboring organs such as the parotid gland. The authors report two cases of chondrosarcoma in the temporomandibular joint in two different patients and discuss their management.

Case report 1

A 54-year-old man with a history of cholecystectomy had left TMJ pain on chewing for 6 years. On examination, the patient presented an asymmetrical face with pre-auricular left swelling and laterodeviation of the mouth at the opening, without facial paralysis, an inflammatory sign of the skin, mouth opening limitation, or cervical nodes. The X-ray radiography showed a widening of left joint space and intra-articular calcifications ( Fig. 1 ). Computed tomography (CT) showed a hypodense process centred on the left TMJ with some calcifications measuring 38 × 20mm, an osteolytic and osteocondensing aspect of the temporal bank, and the condyle head ( Fig. 2 ). Magnetic resonance imaging (MRI) revealed a mass at the level of the well-limited left-wing TMJ on either side of the rising branch. This mass was in heterogeneous T2-weighted imaging (WI) high-intensity signals, low-intensity signals T1-WI heterogeneous measuring 24,5mm of height x 32,9mm of diameter x 43,1mm of transverse diameter. It was low-intensity signals heterogeneous diffusion. No bone abnormality in the mandible against a 9mm bone interruption next to the base of the skull ( Fig. 3 ). The biological analysis was at normal level. The clinical and radiological diagnosis concluded a tumor of the left TMJ. The patient underwent under general anesthesia by pre-auricular approach, surgical excision in a one-block of the tumor carrying the TMJ, the peritumoral tissues, resection of the condylar neck, and the mandibular fossa, without facial nerve damage.

Fig. 1
Panoramic radiography showed widening of left joint space and intra-articular calcifications.

Fig. 2
Computed tomography (CT). (A) Axial and (B) coronal CT scans with soft tissue setting showed a hypodense process centered on the left TMJ with some calcifications measuring 38 × 20mm, an osteolytic and osteocondensing aspect of the temporal bank and the condyle head and.

Fig. 3
Magnetic resonance imaging (MRI) (A) Axial and (B, C) coronal revealed formation at the level of the well-limited left-wing TMJ on either side of the rising branch. This formation is in heterogeneous T2-weighted imaging (WI) high-intensity signals, low-intensity signals T1-WI heterogeneous measuring 24,5mm of height x 32,9mm of diameter x 43,1mm of transverse diameter. It is low intensity signals heterogeneous diffusion. No bone abnormality in the mandible against a 9mm bone interruption next to the base of the skull.

Histological examination showed calcified and ossified cartilaginous proliferation, made up of lobules with variable sizes, constituted with unicellular stalls with chondrocytes of small size or moderate size, rounded or stellate, the seat of discrete nuclear atypia with rarely binucleation, mitosis was not observed. These cells are encased within a chondroid substance, homogeneous rarely myxoid. An aspect of well-differentiated chondrosarcoma from grade I to II ( Fig. 9 ). The postoperative period was favorable with a good mouth-opening and release of the pain. The patient received antibiotics and antalgics daily for 7 days. Considering the high risk of recurrence, the multidisciplinary staff recommended postoperative radiotherapy with a dose of 60 Gy delivered in 30 courses (2 Gy per day 5 times per week). No complications were reported during and after treatment. Follow-up 3, 6, 12, and 24 months for four years did not show signs of recurrence or dysfunction in the TMJ ( Fig. 4 ).

Fig. 4
Photograph of patient. Post-operative scar was noted in the left preauricular region.

Jun 12, 2021 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Diagnostic and therapeutic difficulty of chondrosarcoma of the temporomandibular joint: Two cases report
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